This study aimed to preliminarily investigate the effect of 4 weeks of progressive upper-extremity functional training, including BMI, on hand and upper-extremity function in subacute stroke patients with severe motor paralysis and difficulty extending their hands.
Nine subacute stroke patients with Stroke Impairment Assessment Set (SIAS) upper-extremity distal items 0-1A were recruited. BMI training was conducted for 10 sessions (40 minutes/day) over the first 2 weeks. In weeks 3-4, upper-extremity functional training using the EMG-NMES device or the NMES device (if EMG-NMES was unavailable) was performed for 40 minutes/day over 10 sessions. Upper-extremity motor function was assessed using the Fugl-Meyer Assessment (FMA) and SIAS proximal/distal scores at three time points: before the intervention and at 2 and 4 weeks post-intervention. Event-related desynchronization (ERD) intensities in the alpha (8-13 Hz) and beta (14-30 Hz) bands were calculated daily from EEG data recorded during BMI training. Statistical analysis was performed using the Friedman test for upper-extremity motor function, with multiple comparisons conducted using the Bonferroni method. Wilcoxon's signed-rank test was used to compare alpha- and beta-band ERD intensities between days 1 and 10 of BMI training. The significance level was set at 5 %.
After the BMI training period, 7 of 9 (77.8%) patients transitioned to EMG-NMES training. Upper-extremity motor function, as measured by the FMA total score, significantly improved at both 2 and 4 weeks post-intervention compared with pre-intervention (pre: median [interquartile range] 7[4-16]; 2 weeks: 9[7-23]; 4 weeks: 11[7-26]). Significant improvements were also observed in the FMA shoulder/elbow/forearm (6[4-15], 8[6-20], 9[6-23]), hand (1[0-1], 1[1-1], 2[1-2]), and SIAS distal scores (1A[0-1A]; 1A[1A-1B], 1B[1A-1B]) at 4 weeks compared to pre-intervention. Furthermore, ERD intensity during BMI training significantly increased in the beta band only (day 1: -24.4[-40.0 to -17.7]; day 10: -8.00[-17.7 to 5.5]).
Brain activity in the beta band associated with motor cortex function increased during BMI training. Consistent with previous studies on the chronic phase, subacute stroke patients with severe motor paralysis of the hand successfully transitioned from BMI to EMG-NMES using stepwise training, resulting in improved upper-extremity motor function. Future studies involving control groups are required to validate these findings.
This study may present a viable approach to improving upper-extremity motor function in stroke patients with severe hand paralysis.
Upper-Extremity Motor Function
Subacute Stroke Rehabilitation
